Health Canada Moves to Ban Non-Prescription Codeine Sales

In Niagara Falls, N.Y., it is legally impossible to buy codeine painkillers without a doctor’s approval.

In Canada, however, codeine is widely available without a prescription. In 2013, Canadian pharmacies stocked their shelves with more than $16 million worth of non-prescription codeine, according to estimates by health data company IMS Brogan. This easily translates to hundreds of millions of doses.

These millions of dollars and doses obscure a crucial problem: there is a startling lack of evidence that these drugs work better than household painkillers such as Tylenol or Advil. But their low doses of codeine are addictive — and are driving Canadians into hospitals, addiction treatments and years of opioid dependence.

This is part of the reason for Health Canada’s recent decision to look into banning non-prescription sales of codeine. The department is proposing to make pain pills, cough syrups and other familiar medications that contain codeine available only with a doctor’s prescription.

The regulatory notice says about 600 million low-dose codeine tablets, or about 20 for every person in the country, were sold across Canada in 2015. It notes that more than 500 people entered addiction treatment centres in Ontario alone between 2007 and 2015, with non-prescription codeine as their only problem substance.

Currently, Canadians can buy medications with low doses of codeine — for example, a maximum of 8 mg in a single pill — as long as two other medications are present, normally caffeine and a painkiller such as acetaminophen. The medication must be kept behind the counter at drugstores, where pharmacists are supposed to carefully monitor individual sales to watch for abuse.

But the pharmacists’ checks are often cursory, sometimes merely asking the customer whether they’ve used the medication previously, because clinical and prescription histories are rarely available.

A Toronto Star investigation in 2015 found frequent abuse of the medication, despite warnings from medical experts for decades about the potential for harm. The newspaper’s investigation counted more than 100 codeine products sold in Canada, and about half of them did not require a prescription.

At least two drug manufacturers have ceased providing low-dose codeine products in recent years, and Manitoba last year ended over-the-counter sale of the products. Such products have been among the top-selling medications in Canada.

Australia is also joining a growing list of jurisdictions to announce a ban on over-the-counter sales of products containing codeine. It begin in February.

“Potential changes to Canada’s regulations to require all codeine products to be sold by prescription would be in line with those already in place in many countries, including Belgium, Czech Republic, Finland, France, Greece, Iceland, India, Italy, Norway, Australia, Russia and Sweden.

Health Canada acknowledges that although the prescription-only move could place a greater burden on the health-care system; however, people would be receiving better medical advice about their use around codeine.